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1.
Arq. ciências saúde UNIPAR ; 26(3): 350-366, set-dez. 2022.
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-2205388

ABSTRACT

Introdução: No final do ano de 2019 surgiu na China uma doença infectocontagiosa de característica respiratória e alto grau de disseminação até então desconhecida. No Brasil o primeiro caso de Covid-19 foi confirmado no final de fevereiro de 2020 e a primeira morte em meados de março. Segundo dados da plataforma Coronavírus Brasil, em 17 de março de 2021, houve registro de 11.603.535 casos confirmados e 282.127 óbitos. Objetivo: Descrever o perfil de pessoas que morreram tendo como causa básica do óbito a Covid-19, em um município do Sudoeste do Paraná, entre os anos de 2020 e 2021. Metodologia: Trata-se de um estudo transversal, descritivo, documental de caráter quantitativo que foi realizado na prefeitura municipal de Francisco Beltrão. Resultados: Houve prevalência de óbitos em pacientes do sexo masculino, idosos, com presença de alguma comorbidade associada, sendo hipertensão a mais citada (50,8%). Os sintomas mais prevalentes foram tosse (74,4%), dispneia (56,3%) e saturação < 95% (48,3%), necessitando ainda de hospitalização em algum período da doença (94,1%), sendo os leitos de Sistema Único de Saúde os mais procurados (74,4%). Quanto à taxa de ocupação 49,6% dos casos necessitou apenas de leitos de enfermaria e 42% unidades de terapia intensiva. Discussão: Diversas pesquisas apontam que o sexo masculino é o mais acometido por condições graves de saúde, devido à demora na busca de assistência médica. No que se refere à idade, neste estudo, a prevalência de óbitos se deu entre 71 e 75 anos (15,1%) o que justifica que o envelhecimento é um fator de risco elevado para complicações da doença. Durante a análise dos dados, notou- se que grande parte dos pacientes que tiveram como desfecho o óbito, possuíam algum fator associado, dentre os mais citados, verificou-se a Hipertensão Arterial Sistêmica (50,8%) Diabetes Mellitus (24,8%), doenças cardiovasculares (23,9%) e obesidade (14,7%). No que diz respeito à hospitalização, nesse estudo notou-se que 74,4% da amostra foram hospitalizadas em leitos de SUS, 18,5% em hospitais particulares e 7,1% não possuíam essa informação. Conclusão: É possível observar a importância do estudo epidemiológico para identificar o perfil da população em risco, podendo auxiliar no planejamento do atendimento, rastreamento e controle da doença, além de conhecer a evolução da patologia, a fim de buscar ações adequadas para seu enfrentamento.


Introduction: At the end of 2019, a previously unknown infectious disease with respiratory characteristics and a high degree of dissemination emerged in China. In Brazil the first case of Covid-19 was confirmed in late February 2020 and the first death in mid-March. According to data from the Coronavirus Brazil platform, as of March 17, 2021, 11,603,535 confirmed cases and 282,127 deaths were recorded. Objective: To describe the profile of people who died with Covid-19 as the underlying cause of death in a city in southwestern Paraná between the years 2020 and 2021. Methodology: This is a cross-sectional, descriptive, documental, quantitative study carried out at the Francisco Beltrão City Hall. Results: There was a prevalence of deaths in male patients, elderly, with the presence of some associated comorbidity, hypertension being the most cited (50.8%). The most prevalent symptoms were cough (74.4%), dyspnea (56.3%) and saturation < 95% (48.3%), requiring hospitalization in some period of the disease (94.1%), and the Unified Health System beds were the most sought (74.4%). As for the occupancy rate, 49.6% of the cases required only ward beds and 42% intensive care units. Discussion: Several studies show that men are the most affected by serious health conditions, due to the delay in seeking medical assistance. Regarding age, in this study, the prevalence of deaths was between 71 and 75 years (15.1%), which justifies that aging is a high risk factor for disease complications. During data analysis, it was noted that most patients who died had some associated factor, among the most cited were systemic arterial hypertension (50.8%), diabetes mellitus (24.8%), cardiovascular diseases (23.9%) and obesity (14.7%). Regarding hospitalization, in this study it was noted that 74.4% of the sample were hospitalized in SUS beds, 18.5% in private hospitals, and 7.1% did not have this information. Conclusion: It is possible to observe the importance of the epidemiological study to identify the profile of the population at risk, which can help in planning care, tracking and control of the disease, besides knowing the evolution of the pathology in order to seek appropriate actions for its confrontation


Introducción: A finales del año 2019 apareció en China una enfermedad infecto- contagiosa de característica respiratoria y alto grado de diseminación desconocida hasta entonces. En Brasil se confirmó el primer caso de Covid-19 a finales de febrero de 2020 y la primera muerte a mediados de marzo. Según los datos de la plataforma Coronavirus Brasil, hasta el 17 de marzo de 2021, había 11.603.535 casos confirmados y 282.127 muertes. Objetivo: Describir el perfil de las personas fallecidas con Covid-19 como causa subyacente de muerte en una ciudad del sudoeste de Paraná entre los años 2020 y 2021. Metodología: Se trata de un estudio transversal, descriptivo, documental de carácter cuantitativo que se realizó en la prefectura municipal de Francisco Beltrão. Resultados: Hubo una prevalencia de muertes en pacientes masculinos, de edad avanzada, con presencia de alguna comorbilidad asociada, siendo la hipertensión la más citada (50,8%). Los síntomas más prevalentes fueron la tos (74,4%), la disnea (56,3%) y la saturación < 95% (48,3%), requiriendo hospitalización en algún periodo de la enfermedad (94,1%), siendo las camas del Sistema Único de Salud las más solicitadas (74,4%). En cuanto a la tasa de ocupación, el 49,6% de los casos sólo necesitaban camas de sala y el 42% unidades de cuidados intensivos. Discusión: Varias investigaciones señalan que el género masculino es el más afectado por las condiciones de salud graves, debido al retraso en la búsqueda de asistencia médica. En cuanto a la edad, en este estudio, la prevalencia de muertes se produjo entre los 71 y los 75 años (15,1%), lo que justifica que el envejecimiento sea un factor de riesgo elevado para las complicaciones de la enfermedad. Durante el análisis de los datos, se observó que la mayoría de los pacientes que fallecieron tenían algún factor asociado, entre los más citados estaban la Hipertensión Arterial Sistémica (50,8%), la Diabetes Mellitus (24,8%), las enfermedades cardiovasculares (23,9%) y la obesidad (14,7%). En lo que respecta a la hospitalización, en este estudio se observó que el 74,4% de la muestra estaba hospitalizada en camas del SUS, el 18,5% en hospitales privados y el 7,1% no tenía esta información. Conclusión: Es posible observar la importancia del estudio epidemiológico para identificar el perfil de la población en riesgo, pudiendo ayudar en la planificación de la atención, el rastreo y el control de la enfermedad, además de conocer la evolución de la patología, con el fin de buscar las acciones adecuadas para su enfrentamiento.


Subject(s)
Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Health Profile , Epidemiologic Studies , Epidemiology/statistics & numerical data , Coronavirus Infections/mortality , Coronavirus Infections/rehabilitation , Coronavirus Infections/transmission , Coronavirus Infections/epidemiology , Death , Unified Health System , Aged , Aging/pathology , Cardiovascular Diseases , Global Health/statistics & numerical data , Prevalence , Cough , Diabetes Mellitus , Dyspnea , Oxygen Saturation , Hospitalization , Hypertension , Intensive Care Units/statistics & numerical data , Obesity
2.
Rev Endocr Metab Disord ; 23(2): 293-297, 2022 04.
Article in English | MEDLINE | ID: covidwho-2174753

ABSTRACT

Patients with pre-existing cardiovascular disease (CVD) are at high risk for adverse outcomes with coronavirus disease 2019 (COVID-19). Further, COVID-19 infection is associated with numerous cardiovascular (CV) complications including arrhythmia, myocardial injury, cardiomyopathy, and thrombotic events. Increased susceptibility to COVID-19 and CV complications related to COVID-19 may be in part related to immune dysregulation and inflammation associated with CV disease which is exacerbated with viral infection. Vitamin D plays a major role in immune function and exerts anti-inflammatory effects, which may prove important in the context of CVD and COVID-19. To date, studies have shown minimal benefit for vitamin D supplementation in patients with COVID-19, though there are no studies specific to patients with CVD and related complications. Further, given that vitamin D has important protective effects on the CV system, including augmentation of myocardial contractility and anti-thrombotic effects, it is unknown if supplementation with vitamin D can mitigate CVD complications associated with COVID-19.


Subject(s)
COVID-19 , Cardiovascular Diseases , Vitamin D Deficiency , COVID-19/complications , COVID-19/drug therapy , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Humans , Vitamin D/physiology , Vitamin D/therapeutic use , Vitamin D Deficiency/complications , Vitamin D Deficiency/drug therapy , Vitamins/therapeutic use
3.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.13.23284524

ABSTRACT

COVID-19 syndrome does not occur in all who are infected with SARS-CoV-2, and symptoms vary. The anti-SARS CoV-2 Spike immune responses is confounded by the Spike proteins ability to bind Ig{gamma}3 heavy chains. This appears to be via sialic acid glycans found on the O-Linked glycosylation moieties of this heavy chain extended neck domain. Furthermore glycosylation of light chains, particularly Kappa ({kappa}), is an associated feature of antibodies binding to SARS-CoV-2 antigens nucleocapsid and Spike protein. COVID-19 recovered patients had increased IgG1 and IgM levels and un-glycosylated {kappa} {lambda} light chains; possibly In order to counter this immune system subjugation of IgG3. These molecular finding, together with our previous finding that Spike protein binds glycated human serum albumin (HSA), may explain the micro-vascular inflammatory clots that are a causative feature of COVID-19 acute respiratory syndrome (ARDS). The postulated molecular sequelae are that SARS-CoV-2 virion, entering the blood circulation, being coated with IgG3 and glycated HSA forms a colloid and deposits into micro-focal clots which are also inflammatory. It is not that all IgG3 and albumin is being bound by the virus; this depends on the affinity the SARS-CoV2 virion has for binding an individual IgG3 and albumin due to glycosylation and glycation status. The degree of glycosylation and terminal sialyation of an individuals antibodies is both a genetic and age-maturity dependant feature of the immune system. The degree of HSA glycation is also age related feature particularly related to type 2 diabetes. Thereby establishing the molecular basis of the association of severe COVID-19 disease syndrome and deaths with diabetes, metabolic disorders, and old age. Furthermore, already having cardiovascular disease, with hardened arteries, SARS-CoV2-glycated HSA-IgG3 deposition is going to exacerbate an already compromised circulatory physiology. The binding of IgG3 might also drives a shift in the immune repertoire response to SAR-CoV-2 anti-spike antibodies of increased IgG1 and prolonged IgM levels. This may be associated with Long Covid. In summary, SARS-CoV-2 Spike protein binding of IgG3, via sialic acid glycan residues, along with increased glycosylated {kappa}-light chains and glycated-HSA may form a focal amyloid-like precipitate within blood vessels which in turn leads to the inflammatory micro-thrombosis characteristic of COVID-19 immuno-pathology.


Subject(s)
Cardiovascular Diseases , COVID-19 , Congenital Disorders of Glycosylation , Death , Thrombosis , Severe Acute Respiratory Syndrome , Metabolic Diseases , Diabetes Mellitus
4.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2469492.v1

ABSTRACT

The pandemic has been characterized by several waves defined by viral strains responsible for the predominance of infections. We aimed to analyze the mean length of hospital stay for patients with COVID-19 during the first three waves of the pandemic and its distribution according to sociodemographic and clinical variables. This retrospective study used the notifications of patients hospitalized for COVID-19 in a Brazilian state during the period of the three waves of the disease as the data source. There were 13,910 hospitalizations for confirmed COVID-19 cases. The first wave was the longest, with 4,101 (29.5%) hospitalizations, while the third, although shorter, had a higher number of hospitalized patients (N=6,960). The average length of stay in the hospital was associated with age groups up to 59 years old and from 60 to 79 y.o., high school and higher education, pregnant women (P=0,036) white and non-white race, female and male sex, and residents of the urban area (P < 0.05). Regarding the presence of comorbidities, there was a statistically significant difference in the mean number of days of hospitalization among patients with chronic cardiovascular disease, diabetes mellitus, and obesity (P< 0.05). In conclusion, the COVID-19 pandemic has been distinctly revealed among the waves.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus , Obesity
5.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2468706.v1

ABSTRACT

Background The mechanisms used by SARS-CoV-2 to induce major adverse cardiac events (MACE) are unknown. Thus, we aimed to determine if SARS-CoV-2 can infect the heart to kill cardiomyocytes and induce MACE in patients with severe COVID-19. Methods This observational prospective cohort study includes experiments with hamsters and human samples from patients with severe COVID-19. Cytokines and serum biomarkers were analyzed in human serum. Cardiac transcriptome analyses were performed in hamsters' hearts. Results From a cohort of 70 patients, MACE was documented in 26% (18/70). Those who developed MACE had higher Log copies/mL of SARS-CoV-2, troponin-I, and pro-BNP in serum. Also, the elevation of IP-10 and a major decrease in levels of IL-17ɑ, IL-6, and IL-1rɑ were observed. No differences were found in the ability of serum antibodies to neutralize viral spike proteins in pseudoviruses from variants of concern. In hamster models, we found a stark increase in viral titers in the hearts 4 days post-infection. The cardiac transcriptome evaluation resulted in the differential expression of ~ 9% of the total transcripts. Analysis of transcriptional changes of the effectors of necroptosis (mixed lineage kinase domain-like, MLKL) and pyroptosis (gasdermin D) showed necroptosis, but not pyroptosis, to be elevated. Active form of MLKL (phosphorylated MLKL, pMLKL) was elevated in hamster hearts and, most importantly, in the serum of MACE patients. Conclusion SARS-CoV-2 can reach the heart during severe COVID-19 and induce necroptosis in the heart of patients with MACE. Thus, pMLKL could be used as a biomarker of cardiac damage and a therapeutic target. Trial registration: Not applicable.


Subject(s)
Cardiovascular Diseases , Heart Diseases , COVID-19 , Severe Acute Respiratory Syndrome
6.
researchsquare; 2023.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2449452.v1

ABSTRACT

This retrospective study explored the changes in biomarkers indicators and prognosis in COVID-19 patients with mental disorders (n = 60) from the author’ Hospital between 2/13/2020 and 4/15/2020. Significant differences before and after negative conversion were observed in lymphocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, aspartate aminotransferase, albumin, albumin/globulin ratio, direct bilirubin, alkaline phosphatase, uric acid, high-density lipoprotein cholesterol, and ApoA1 (all P < 0.05). Compared with the patients who had a negative conversion within 3 weeks, those who did not turn negative within 3 weeks had a higher frequency of cardiovascular diseases (27.3% vs. 4.2%, P = 0.040), a higher lymphocyte-to-monocyte ratio (median, 4.72 vs. 3.35, P = 0.003), and higher total bilirubin levels (median, 12.0 vs. 8.6 µmol/L, P = 0.031). The results present the changes in laboratory parameters in COVID-19 patients with a mental disorder. Cardiovascular diseases and higher lymphocyte-to-monocyte ratio, and total bilirubin levels could be associated with the amount of time required for negative conversion.


Subject(s)
Mental Disorders , Cardiovascular Diseases , Hyperbilirubinemia , COVID-19
7.
medrxiv; 2023.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2023.01.04.23284174

ABSTRACT

Background: The COVID-19 pandemic disrupted healthcare and may have impacted ethnic inequalities in healthcare. We aimed to describe the impact of pandemic-related disruption on ethnic differences in clinical monitoring and hospital admissions for non-COVID conditions in England. Methods We conducted a cohort study using OpenSAFELY (2018-2022). We grouped ethnicity (exposure), into five categories: White, South Asian, Black, Other, Mixed. We used interrupted time-series regression to estimate ethnic differences in clinical monitoring frequency (e.g., blood pressure measurements) before and after 23rd March 2020. We used multivariable Cox regression to quantify ethnic differences in hospitalisations related to: diabetes, cardiovascular disease, respiratory disease, and mental health before and after 23rd March 2020. Findings Of 14,930,356 adults in 2020 with known ethnicity (92% of sample): 86.6% were White, 7.3% Asian, 2.6% Black, 1.4% Mixed ethnicity, and 2.2% Other ethnicities. Clinical monitoring did not return to pre-pandemic levels for any ethnic group. Ethnic differences were apparent pre-pandemic, except for diabetes monitoring, and remained unchanged, except for blood pressure monitoring in those with mental health conditions where differences narrowed during the pandemic. For those of Black ethnicity, there were seven additional admissions for diabetic ketoacidosis per month during the pandemic, and relative ethnic differences narrowed during the pandemic compared to White. There was increased admissions for heart failure during the pandemic for all ethnic groups, though highest in White ethnicity. Relatively, ethnic differences narrowed for heart failure admission in those of Asian and Black ethnicity compared to White. For other outcomes the pandemic had minimal impact on ethnic differences. Interpretation Our study suggests ethnic differences in clinical monitoring and hospitalisations remained largely unchanged during the pandemic for most conditions. Key exceptions were hospitalisations for diabetic ketoacidosis and heart failure, which warrant further investigation to understand the causes. Funding LSHTM COVID-19 Response Grant (DONAT15912).


Subject(s)
Cardiovascular Diseases , Diabetic Ketoacidosis , Heart Failure , COVID-19 , Respiratory Tract Diseases , Diabetes Mellitus
8.
Arq Neuropsiquiatr ; 80(4): 375-383, 2022 04.
Article in English | MEDLINE | ID: covidwho-2162678

ABSTRACT

BACKGROUND: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. OBJECTIVE: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. METHODS: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. RESULTS: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. CONCLUSION: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.


Subject(s)
COVID-19 , Cardiovascular Diseases , Delirium , COVID-19/complications , Delirium/diagnosis , Delirium/epidemiology , Delirium/etiology , Humans , Retrospective Studies , Seizures/etiology
9.
Am Fam Physician ; 106(1): 61-69, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2156674

ABSTRACT

This article summarizes the top 20 research studies of 2021 identified as POEMs (patient-oriented evidence that matters) that did not address the COVID-19 pandemic. Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists prevent adverse cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and also reduce all-cause and cardiovascular mortality. Most older adults (mean age, 75 years) with prediabetes do not progress to diabetes. Among patients in this age group with type 2 diabetes treated with medication, an A1C level of less than 7% is associated with increased risk of hospitalization for hypoglycemia, especially when using a sulfonylurea or insulin. For patients with chronic low back pain, exercise, nonsteroidal anti-inflammatory drugs, duloxetine, and opioids were shown to be more effective than control in achieving a 30% reduction in pain, but self-discontinuation of duloxetine and opioids was common. There is no clinically important difference between muscle relaxants and placebo in the treatment of nonspecific low back pain. In patients with chronic pain, low- to moderate-quality evidence supports exercise, yoga, massage, and mindfulness-based stress reduction. For acute musculoskeletal pain, acetaminophen, 1,000 mg, plus ibuprofen, 400 mg, without an opioid is a good option. Regarding screening for colorectal cancer, trial evidence supports performing fecal immunochemical testing every other year. For chronic constipation, evidence supports polyethylene glycol, senna, fiber supplements, magnesium-based products, and fruit-based products. The following abdominal symptoms carry a greater than 3% risk of cancer or inflammatory bowel disease: dysphagia or change in bowel habits in men; rectal bleeding in women; and abdominal pain, change in bowel habits, or dyspepsia in men and women older than 60 years. For secondary prevention in those with established arteriosclerotic cardiovascular disease, 81 mg of aspirin daily appears to be effective. The Framingham Risk Score and the Pooled Cohort Equations both overestimate the risk of cardiovascular events. Over 12 years, no association between egg consumption and cardiovascular events was demonstrated. Gabapentin, pregabalin, duloxetine, and venlafaxine provide clinically meaningful improvements in chronic neuropathic pain. In patients with moderate to severe depression, initial titration above the minimum starting dose of antidepressants in the first eight weeks of treatment is not more likely to increase response. In adults with iron deficiency anemia, adding vitamin C to oral iron has no effect. In children with pharyngitis, rhinosinusitis, acute bronchitis, or acute otitis media, providing education combined with a take-and-hold antibiotic prescription results in 1 in 4 of those children eventually taking an antibiotic.


Subject(s)
COVID-19 , Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Low Back Pain , Physicians, Primary Care , Sodium-Glucose Transporter 2 Inhibitors , Aged , Analgesics, Opioid , Anti-Bacterial Agents , COVID-19/complications , Child , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Duloxetine Hydrochloride , Female , Humans , Male , Pandemics , Physicians, Primary Care/education
10.
Biomolecules ; 12(10)2022 10 21.
Article in English | MEDLINE | ID: covidwho-2154887

ABSTRACT

Cardiovascular diseases (CVD) represent the leading cause of death in the world despite innovations in therapies and advances in the general management of patients [...].


Subject(s)
Cardiology , Cardiovascular Diseases , Humans , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/genetics , Cardiovascular Diseases/therapy , Biomarkers
11.
BMJ Open ; 12(11): e064237, 2022 11 10.
Article in English | MEDLINE | ID: covidwho-2152996

ABSTRACT

OBJECTIVES: The NHS Health Check offers adults aged 40-74 an assessment of their risk of developing cardiovascular disease. Attendees should be offered appropriate clinical or behavioural interventions to help them to manage or reduce these risks. This project focused on understanding variation in the advice and support offered to Health Check attendees. DESIGN: We conducted a realist review, assembling a diverse body of literature via database searches (MEDLINE, Embase, CINAHL, HMIC, Web of Science) and other search methods, and synthesised data extracted from documents using a realist logic of analysis. Our aim was to develop an understanding of contexts affecting delivery of the NHS Health Check and the underlying mechanisms producing outcomes related to the offer for attendees post-Check. RESULTS: Our findings demonstrate differences in how NHS Health Check commissioners, providers and attendees understand the primary purpose of the programme. A focus on screening for disease can produce an emphasis on high-volume delivery in primary care. When delivery models are organised around behavioural approaches to risk reduction, more emphasis is placed on advice, and referrals to 'lifestyle services'. However, constrained funding and competing priorities for providers limit what can be delivered within the programme's remit. Attendees' experiences and responses to the programme are affected by how the programme is delivered, and by the difficulty of incorporating its outputs into their lives. CONCLUSIONS: The remit of the NHS Health Check should be reviewed with consideration of what can be effectively delivered within existing resources. Variation in delivery may be appropriate to meet local needs, but differences in how the programme's primary purpose is understood contribute to a 'postcode lottery' in post-Check advice and support. Our findings underline existing concerns that the programme may generate inequitable outcomes and raise questions about whether it can deliver positive outcomes for the majority of attendees. TRIAL REGISTRATION NUMBER: PROSPERO CRD42020163822.


Subject(s)
Cardiovascular Diseases , State Medicine , Adult , Humans , Cardiovascular Diseases/prevention & control , Mass Screening
12.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2413065.v1

ABSTRACT

COVID-19 aggravates pre-existing diabetes mellitus and contributes to newly discovered hypertension by increasing blood pressure by inhibiting the activity of angiotensin-converting enzymes 2 in the rennin-angiotensin system. Diabetes patients may be more vulnerable to COVID-19 due to chronic comorbidities such as obesity and cardiovascular disease such as hypertension. On March 23, 2022, a retired black African woman in her sixties was taken into the emergency room with the chief complaints of frequent midnight urine, hazy vision, headache, fever, and tingling in her hands and feet. A throat swab polymerase chain reaction test that revealed positive results after 28 hours was used to confirm COVID-19. Her electrocardiogram showed sinus tachycardia with a heart rate of 105 beats per minute. Fluid resuscitation (0.9% normal saline) of 1000 mL and drip insulin administration were commenced as soon as she was brought to an intensive care unit. In this case report, the patient had been previously diagnosed with type 2 diabetes mellitus. COVID-19 affects the beta cells, forcing them to release insulin and increasing the insulin insufficiency, which leads to her blood glucose raising. Type 2 diabetes mellitus is therefore the most frequent comorbidity of COVID-19 in this case report. Poor blood glucose management in the case of COVID-19 may increase the pathogen's susceptibility, the likelihood that patients will be admitted to the hospital, and the likelihood that mortality will be enhanced.


Subject(s)
Cardiovascular Diseases , Diabetes Mellitus, Type 2 , Tachycardia, Sinus , COVID-19 , Hypertension , Headache , Fever , Obesity , Diabetes Mellitus , Addison Disease
13.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2413127.v1

ABSTRACT

Cardiovascular disease is the primary reason of death within a short period because of a sudden blockage in blood vessels. Therefore, early diagnosis and treatments are necessary to reduce the disease severity. In this study, Image augmentation concepts are used for balancing the ECG images dataset classes. The balanced dataset contains 6322 images from five different classes are Normal, Abnormal Heartbeat, Myocardial Infraction (MI), Previous History of MI, and Covid-19 ECG images. The pre-trained models VGG-16, ResNet-50, and DenseNet-161 are used to train on ECG balanced dataset. The use of hyper-parameters will increase the accuracy of classifying cardiovascular disorders which includes learning rate, optimizer, and dropout. The mentioned pre-trained models reported the highest accuracy at learning rate = 0.00001 and dropout=0.3 with Adam optimizer. DenseNet model achieved 93.33% accuracy, 94.23% precision, 93.33% recall, and 93.30% F1-Score, which is higher in performance compared to ResNet-50 and VGG-16 pre-trained models.


Subject(s)
Cardiomyopathies , COVID-19 , Cardiovascular Diseases
14.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-2410165.v1

ABSTRACT

Background The accurate incidence of different cardiovascular consequences of COVID-19 in pediatric population have been inadequately defined due to ongoing genotype changes in the virus. Although COVID-19 is known to increase inflammatory markers associated with atrial arrhythmias, the contemporary literature has poorly described new onset arrhythmias as a complication in previously healthy neonate with COVID-19 Case presentation Twenty-day-old female term neonate, born by caesarean section with immediate cry developed labored breathing, cyanosis and tachycardia after having close contact with a confirmed case of covid-19. She developed atrial flutter, which was refractory to cardioversion and drugs namely Amiodarone, Flecainide and Propranolol. The neonate was treated with IVIG. This is the first reported case of atrial flutter in neonatal period secondary to COVID-19. Conclusion Since the starting of SARS –COV2 pandemic all attentions and concerns has been mainly on respiratory manifestations and complications. The cardiovascular complications and treatment are neglected. This case reports tachyarrhythmia (Atrial Flutter) as unusual presentation of MISC in neonatal population and show role of IvIg in treatment of refractory arrhythmias.


Subject(s)
Cardiovascular Diseases , COVID-19 , Labor Pain , Cyanosis , Tachycardia , Atrial Flutter , Arrhythmias, Cardiac
15.
BMC Public Health ; 22(1): 1949, 2022 10 20.
Article in English | MEDLINE | ID: covidwho-2139209

ABSTRACT

OBJECTIVES: Protective vaccinations are important in maintaining health and reducing suffering from infectious diseases. Also, vaccine-preventable infectious diseases are associated with the development and progression of cardiovascular diseases. AIM: The study aimed to test adults' knowledge of the role of protective vaccinations in the prevention of cardiovascular diseases, and their opinions on the quantity of the information provided by doctors in this regard. METHODS: A total of 700 adults participated in the study, most of whom were women (500; 71.43%). The study used an original questionnaire containing questions covering vaccinations and cardiovascular diseases, and the general characteristics of the participants. The inclusion criteria for the study were 18 years of age and written informed consent to participate in the study. RESULTS: Over 60% of the participants did not know of, or denied the possibility of, developing cardiovascular diseases as a result of avoiding required preventive vaccinations. More than half of the participants stated that there is no need to recommend influenza vaccination to patients with cardiovascular diseases. Over 70% of participants stated that family doctors did not provide sufficient information about protective vaccinations. CONCLUSION: In these adults, knowledge of the role of preventive vaccinations in the prevention of cardiovascular diseases was low, and the quantity of the information provided by doctors about preventive vaccinations were considered to be insufficient. Public awareness of the effects of avoiding preventive vaccinations should be raised especially among people with CVD.


Subject(s)
Cardiovascular Diseases , Communicable Diseases , Vaccines , Adult , Humans , Female , Male , Cardiovascular Diseases/prevention & control , Health Knowledge, Attitudes, Practice , Vaccination
16.
Ther Adv Cardiovasc Dis ; 16: 17539447221137170, 2022.
Article in English | MEDLINE | ID: covidwho-2139019

ABSTRACT

BACKGROUND: Management of high blood pressure (BP) typically requires adherence to medication regimes. However, it is known that the COVID-19 pandemic both interrupted access to some routine prescriptions and changed some patient health behaviours. AIM: This study, therefore, retrospectively investigated prescription reimbursement of cardiovascular (CVD) medicines as a proxy measure for patient adherence and access to medicines during the pandemic. METHODS: A cohort study of all primary care patients in England prescribed CVD medicines. The exposure was to the global pandemic. Prescriptions were compared before and after the pandemic's onset. Statistical variation was the outcome of interest. RESULTS: Descriptive statistics show changes to monthly prescriptions, with wide confidence intervals indicating varying underlying practice. Analysis of variance reveals statistically significant differences for bendroflumethiazide, potassium-sparing diuretics, nicorandil, ezetimibe, ivabradine, ranolazine, colesevelam and midodrine. After the pandemic began (March-October 2020), negative parameters are observed for ACE inhibitors, beta-blockers, calcium channel blockers, statins, antiplatelet, antithrombotics, ARBs, loop diuretics, doxazosin, bendroflumethiazide, nitrates and indapamide, indicating decelerating monthly prescription items (statistically significant declines of calcium channel blockers, antithrombotic, adrenoreceptor blockers and diuretics) of CVD medicines within the general population. Many data points are not statistically significant, but fluctuations remain clinically important for the large population of patients taking these medications. CONCLUSION: A concerning decline in uptake of CVD therapies for chronic heart disease was observed. Accessible screening and treatment alongside financial relief on prescription levies are needed. A video abstract is (4 min 51 s) available: https://bit.ly/39gvEHi.


Subject(s)
COVID-19 , Cardiovascular Agents , Cardiovascular Diseases , Heart Diseases , Humans , Pandemics , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Bendroflumethiazide , Retrospective Studies , Cohort Studies , Angiotensin Receptor Antagonists , Cardiovascular Agents/adverse effects , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/epidemiology , Heart Diseases/drug therapy , Diuretics/therapeutic use , Drug Prescriptions
17.
Int J Immunopathol Pharmacol ; 36: 3946320221141802, 2022.
Article in English | MEDLINE | ID: covidwho-2138625

ABSTRACT

OBJECTIVE: With the global epidemic of coronavirus disease 2019 (COVID-19), vaccination rates are increasing globally. This study evaluated the relevant clinical manifestations of vaccinated COVID-19 patients. METHODS: We searched carefully in 11 databases such as PubMed, Embase, Scopus, Cochrane Library, Web of Science, Ovid, China National Knowledge Infrastructure Database, Wan Fang Data, Sinomed, VIP Database, and Reading Showing Database up to 26 March 2022. To search for articles that have described the characteristics of vaccinated patients including epidemiological and clinical symptoms. Statistical analysis of the extracted data using STATA 14.0. RESULTS: A total of 58 articles and 263,708 laboratory-confirmed COVID-19 patients were included. Most of the patients in the vaccinated group had more asymptomatic infection and fewer severe illnesses. There were significant differences in ethnicity, and strain infected with COVID-19, and comorbidities (hyperlipidemia, diabetes, obesity, kidney disease, immunocompromised, cardiovascular disease, and tumor) and symptoms (fever, cough, gastrointestinal symptoms, neurological symptoms, and dysgeusia/anosmia) between vaccinated group and unvaccinated group. Oxygen support, use of steroid, days in hospital, hospital treatment, ICU treatment, death, and poor prognosis were also significantly different. CONCLUSION: Compared with the vaccinated group, patients in the unvaccinated group had a more severe clinical manifestations. Vaccines are also protective for infected people.


Subject(s)
COVID-19 , Cardiovascular Diseases , Neoplasms , Humans , China , COVID-19/epidemiology , COVID-19/prevention & control , Research Design
18.
BMJ Open ; 12(11): e066868, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2137796

ABSTRACT

OBJECTIVES: The North East of England, ranked as having the highest poverty levels and the lowest health outcomes, has the highest cardiovascular disease (CVD) premature mortality. This study aimed to compare CVD-related conditions and risk factors for deprived practice populations with other general practice (GP) populations in Northern England to England overall, before and during COVID-19 to identify changes in recorded CVD-related risk factors and conditions and evidence-based lipid prescribing behaviour. DESIGN: A population-based observational study of aggregated practice-level data obtained from publicly accessible data sets. SETTING: 34 practices that fall into the 15% most deprived practice populations in England were identified as the most deprived communities in the North East and North Cumbria (Deep End). PARTICIPANTS: Patients aged ≥16 registered with GP and diagnosed with any form of CVD. PRIMARY AND SECONDARY OUTCOME MEASURES: CVD-related conditions and risk factors, statin prescribing. RESULTS: Deep End (n=263 830) had a smaller, younger and more deprived population with lower levels of employment and full-time education and higher smoking prevalence. They had some higher recorded CVD-related conditions than England but lower than the non-Deep End. Atrial fibrillation (-0.9, -0.5), hypertension (-3.7, -1.3) and stroke and transient ischaemic attack rates (-0.5, -0.1) appeared to be lower in the Deep End than in the non-Deep End but the optimal statin prescribing rate was higher (3.1, 8.2) than in England. CONCLUSION: Recorded CVD-related risk factors and conditions remained comparable before and during COVID-19. These are higher in the Deep End than in England and similar or lower than the non-Deep End, with a higher optimal statin prescribing rate. However, it was not possible to control for age and sex. More work is needed to estimate the consequences of the pandemic on disadvantaged communities and to compare whether the findings are replicated in other areas of deprivation.


Subject(s)
COVID-19 , Cardiovascular Diseases , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Humans , Cardiovascular Diseases/epidemiology , COVID-19/epidemiology , Risk Factors , England/epidemiology , Primary Health Care
19.
Heart ; 108(4): 258-265, 2022 02.
Article in English | MEDLINE | ID: covidwho-2137872

ABSTRACT

Ramadan fasting is observed by most of the 1.8 billion Muslims around the world. It lasts for 1 month per the lunar calendar year and is the abstention from any food and drink from dawn to sunset. While recommendations on 'safe' fasting exist for patients with some chronic conditions, such as diabetes mellitus, guidance for patients with cardiovascular disease is lacking. We reviewed the literature to help healthcare professionals educate, discuss and manage patients with cardiovascular conditions, who are considering fasting. Studies on the safety of Ramadan fasting in patients with cardiac disease are sparse, observational, of small sample size and have short follow-up. Using expert consensus and a recognised framework, we risk stratified patients into 'low or moderate risk', for example, stable angina or non-severe heart failure; 'high risk', for example, poorly controlled arrhythmias or recent myocardial infarction; and 'very high risk', for example, advanced heart failure. The 'low-moderate risk' group may fast, provided their medications and clinical conditions allow. The 'high' or 'very high risk' groups should not fast and may consider safe alternatives such as non-consecutive fasts or fasting shorter days, for example, during winter. All patients who are fasting should be educated before Ramadan on their risk and management (including the risk of dehydration, fluid overload and terminating the fast if they become unwell) and reviewed after Ramadan to reassess their risk status and condition. Further studies to clarify the benefits and risks of fasting on the cardiovascular system in patients with different cardiovascular conditions should help refine these recommendations.


Subject(s)
Cardiovascular Diseases , Heart Failure , Cardiovascular Diseases/therapy , Fasting/adverse effects , Heart Failure/therapy , Humans , Islam
20.
Circulation ; 141(20): 1648-1655, 2020 May 19.
Article in English | MEDLINE | ID: covidwho-2138307

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a global pandemic affecting 185 countries and >3 000 000 patients worldwide as of April 28, 2020. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2, which invades cells through the angiotensin-converting enzyme 2 receptor. Among patients with COVID-19, there is a high prevalence of cardiovascular disease, and >7% of patients experience myocardial injury from the infection (22% of critically ill patients). Although angiotensin-converting enzyme 2 serves as the portal for infection, the role of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers requires further investigation. COVID-19 poses a challenge for heart transplantation, affecting donor selection, immunosuppression, and posttransplant management. There are a number of promising therapies under active investigation to treat and prevent COVID-19.


Subject(s)
Betacoronavirus , Cardiovascular Diseases , Coronavirus Infections , Pandemics , Peptidyl-Dipeptidase A , Pneumonia, Viral , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 , Cardiovascular Diseases/complications , Cardiovascular Diseases/enzymology , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/enzymology , Coronavirus Infections/therapy , Coronavirus Infections/virology , Humans , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/complications , Pneumonia, Viral/enzymology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Receptors, Virus/antagonists & inhibitors , Receptors, Virus/metabolism , SARS-CoV-2
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